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Randall et al. Plast Aesthet Res 2024;11:18 Plastic and
DOI: 10.20517/2347-9264.2023.115
Aesthetic Research

Review Open Access

Correction and prevention of tip asymmetries,
bossae, and alar retraction

Nicholas R. Randall, Lazaro R. Peraza, Grant S. Hamilton III

Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Correspondence to: Dr. Grant S. Hamilton III, Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, 200 1st St
SW, Rochester, MN 55905, USA. E-mail: hamilton.grant@mayo.edu

How to cite this article: Randall NR, Peraza LR, III GSH. Correction and prevention of tip asymmetries, bossae, and alar
retraction. Plast Aesthet Res 2024;11:18. https://dx.doi.org/10.20517/2347-9264.2023.115
Received: 13 Nov 2023 First Decision: 24 Apr 2024 Revised: 9 May 2024 Accepted: 21 May 2024 Published: 29 May 2024

Academic Editors: Stefano Gentileschi, Paolo Boffano Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Secondary rhinoplasty to address complications from initial surgical intervention is a technically challenging
operation. Common aesthetic complications that plague patients after primary rhinoplasty include nasal tip
asymmetries, bossae, and alar retraction. These adverse outcomes are usually a result of over-manipulation and/or
over-excision of native cartilage and are especially prevalent in patients with thick lower lateral cartilages and thin
nasal skin. Techniques to minimize tissue handling, maintain natural nasal anatomic support and structure, and
soften sharp edges from cartilage grafts or incisions are all essential in the prevention of nasal tip irregularities. In
addition to prevention, there are many operative and procedural interventions to correct tip asymmetries, bossae,
and alar retraction. These interventional corrections include varying cartilage and/or fascial grafts, camouflaging of
previously performed grafts, and repositioning of the alar cartilage.

Keywords: Secondary rhinoplasty, complications, bossae, nasal tip asymmetry, alar retraction

INTRODUCTION
[1]
Rhinoplasty is a complex operation referred to as the “queen of facial plastic surgery” . Patients often seek
rhinoplasty for a myriad of reasons, often driven by aesthetic aspirations, traumatic deformities,
dissatisfaction with previous surgical outcomes, or the development of a new deformity after the initial
[2]
surgery .

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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